Frequency of glucose‐6‐phosphate dehydrogenase–deficient red blood cell units in a metropolitan transfusion service

BACKGROUND: Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency is characterized by red blood cell (RBC) destruction in response to oxidative stress. Although blood donors are not routinely screened for G6PD deficiency, the transfusion of stored G6PD‐deficient RBCs may have serious adverse outcomes. By measuring G6PD enzyme activity of RBC units from a large metropolitan hospital transfusion service, we sought to determine 1) the prevalence of G6PD‐deficient RBC units, 2) if G6PD activity changes during storage, and 3) if G6PD activity in segments correlates with its activity in the bags. STUDY DESIGN AND METHODS: Quantitative G6PD activity was measured in 301 randomly selected RBC units and 73 D+C?E? (i.e., R₀r or R₀R₀) RBC units, all stored in additive solutions. G6PD deficiency was defined as activity less than 60% of the normal mean. RESULTS: The frequency of G6PD‐deficient units in the general inventory was 0.3% (1/301; 95% confidence interval [CI], <0.01%‐2.1%). In contrast, its frequency in D+C?E? RBC units was 12.3% (9/73; 95% CI, 6.4%‐22.0%). G6PD activity did not significantly change during the 42‐day storage period, and G6PD activity measured in RBC storage bags and attached segments correlated well (r = 0.7‐0.9, p ≤ 0.001, Spearman rank correlation). CONCLUSIONS: Although the frequency of G6PD‐deficient RBC units in the transfusion service general inventory was relatively low, it was significantly higher among a subset of R₀r or R₀R₀ units. The latter are preferentially allocated for transfusion to patients with sickle cell disease to decrease the risk of RBC alloimmunization, possibly allowing more of these units to be inadvertently targeted to these patients.     

MEBT/MEBO 综合疗法治愈30例眼角膜火碱烧伤

目的：根据湿润暴露疗法的基本理论，探讨MEBT/MEBO治疗眼角膜火碱烧伤的作用。方法：应用MEBT/MEBO综合疗法治疗30例(42眼)。结果：患者眼视力均恢复至0．6以上，且角膜清晰可见。结论：打破了传统医学认为眼科治疗关于前弹力层及其实质层损伤后不能再生的传统观念，开创了中西医结合治疗眼角膜火碱烧伤的美好前景。     

Polyneuropathy Associated with IgA Paraproteinemia and Amyloidosis: A Case Report and Literature Review

Paraproteinemia potentially causes peripheral neuropathy via an unknown underlying pathogenetic mechanism. We report a case of pathologically proven amyloid neuropathy with AL amyloidosis with an IgA kappa light chain, which was initially diagnosed as neuropathy associated with monoclonal gammopathy of undetermined significance. This case indicates that in cases of neuropathy with paraproteinemia, the other potential causes should be excluded by appropriate means, especially pathological evaluations.     

Early blood lactate area as a prognostic marker in pediatric septic shock

Purpose

We attempted to evaluate whether the early lactate area is useful as an early prognostic marker of mortality in pediatric septic shock patients.

Methods

We performed a retrospective study of pediatric patients with septic shock who were admitted to the pediatric intensive care unit of Asan Medical Center, Seoul, Korea. Serial arterial lactate levels were obtained immediately and then every 6 h after admission for a total of 24 h. The lactate area (mmol/lh) was defined as the sum of the area under the curve (AUC) of serial lactate levels measured during the 24 h following admission. We compared the lactate-associated parameters as a predictor of mortality.

Results

A total of 65 patients were included in this study, and the overall 28-day mortality of these patients was 26.2 %. Survivors compared with non-survivors had an initial lactate level of 3.13 ± 2.79 vs. 6.16 ± 4.87 mmol/l, a lactate clearance of 32.8 ± 63.4 vs. ?30.8 ± 75.6 %, and a lactate area of 59.7 ± 56.0 vs. 168.0 ± 107.0 mmol/lh (p < 0.05 for all variables). Receiver operating characteristic curves indicated a strong predictive power for the lactate area (AUC = 0.828), which demonstrated the largest AUC in comparison with the AUCs of the initial lactate level (0.699) or the 24-h lactate clearance (0.719). Using multivariate logistic regression analysis, the lactate area was a significant prognostic factor.

Conclusion

The early lactate area is a potentially feasible and clinically useful predictor of mortality in pediatric septic shock patients.